[Rehabilitation of the crippled child in Suecia: detection of the crippled child].
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[Reformatory educational approaches in early special education of the physically handicapped - a survey based on the "Journal for the Care of Cripples" 1909--1929 (author's transl)].
An historical survey of special education of the physically handicapped is necessary because the dialectic relationship between the educational attention for the physically handicapped on the one hand and the educational rejection of the most severely handicapped on the other hand, seems to be occurring today as in the first decades of this century. At first, the article reviews the social-biological approach of the orthopaedist K. Biesalski and the "educational psychology of cripples" of H. Würtz, who worked together with Biesalski. The educational demands for cripples which result from their theories are briefly described. The influence of reformatory educational theory on both the pre-scientific educational theories concerning cripples before 1920 and the experimental-psychological and special educational concepts until 1929 are outlined. Finally the article analyses the resource material including articles of Agahd 1909; Delitsch 1909; Denzer 1910; Plass 1912; Würtz 1912, 1913; Legel 1914; Köhler 1926; Herold 1929 und Winkler 1929.
Child↗
The subcutaneous mastectomy cripple: surgical rehabilitation with the latissimus dorsi flap.
Despite the advances in reconstruction after subcutaneous mastectomy, we have seen a group of patients who have developed disabling complications of their surgery. These patients have become "subcutaneous mastectomy cripples." In general, these patients have two primary reconstructive problems: (1) inadequate coverage of their silicone implant, and (2) loss of breast skin from infection and ischemic necrosis of skin flaps. The latissimus dorsi flap easily corrects these two defects. We have presented our experience with the "subcutaneous mastectomy cripple" and described the use of latissimus dorsi muscle and musculocutaneous flaps in their management.
Adult↗
Psychological disorders in crippled children. A comparative study of children with and without brain damage.
A detailed standardised study was made of all crippled children aged between five and 15 years and of normal intelligence on the local-authority lists of handicapped children in three London boroughs. Psychiatric disorder was twice as common in children whose crippling was due to cerebral disease or damage rather than some peripheral lesion. As the groups were well matched in terms of physical incapacity and social background, it was concluded that brain damage was responsible for the children's increased vulnerability to emotional problems. Brain damage was also associated with a marked increase in reading difficulties and a lowering of intelligence within the normal range. Psychiatric disorder was found to be related not only to cerebral injury but also to various types of family disturbance. It is concluded that emotional and behavioural disturbance stemmed from both an increased biological vulnerability and psychosocial hazards.
Adolescent↗
[Role of the family in the rehabilitation of crippled children].
The article contains the findings of a socio-hygienic survey of families with crippled children suffering from cerebral palsy. A description is made of the procedure for conducting a survey based of International Classification of disorders, lowering of ability to work, social inadequacy and methods of factor analysis. The main socio-hygienic factors which characterize the families with crippled children and influence the process of medico-social rehabilitation of children were obtained on the basis of factor analysis.
Adolescent↗
Pathology of the skeleton and tendons of broiler chickens reared to roaster weights. I. Crippled chickens.
The incidence of cripples among broiler chickens kept until 74 days of age was greatest in chickens fed ad libitum and kept in batteries. The incidence was lower in chickens kept in floor pens and was reduced by feed restriction. Crippling was due to long-bone distortion, rupture of the gastrocnemius tendon, and spondylolisthesis. Long-bone distortion was the most common defect and could be divided into valgus and varus deformation. The former was more important in chickens less than 7 weeks of age, and the latter was more important in older chickens. Tibial dyschondroplasia was found in some chickens with long-bone distortion, and the possible significance of this abnormal cartilage as a cause of long-bone distortion is discussed.
Animals↗
Gracilis muscle sling for select incontinent "bladder exstrophy cripples".
PURPOSE: Functional reconstruction of children born with bladder exstrophy results in a successful outcome in the majority. However, failed bladder neck repair, especially after multiple surgical attempts, compromises the quality of the tissues and, thus, limits surgical options. In these cases conventional sphincteroplasty and other continence procedures, such as rectus sheath sling or artificial urinary sphincters, are ill-advised due to ischemia and fibrosis of the bladder neck. MATERIALS AND METHODS: We transferred the gracilis muscle as a vascularized pedicle flap around the bladder neck in 5 children born with bladder exstrophy, of whom 3 were "exstrophy cripples" with multiple previous failed attempts at reconstruction, and 2 were older with failed prior attempts at bladder closure. In the latter 2 cases a 1-stage repair was performed, which included bladder augmentation, ureteroneocystotomy, epispadias repair and bladder neck wrap with gracilis muscle. The other 3 children underwent gracilis muscle wrap of the compromised bladder neck. RESULTS: All 5 children were dry between clean intermittent catheterization 2 to 13 years postoperatively. Complications included urinary tract infection in all 5 cases, stomal stenosis in 2, small bowel obstruction in 1 and bladder stones in 2. However, no complication was related to the gracilis muscle transfer. CONCLUSIONS: Vascularized gracilis muscle flap can be used to wrap around the compromised bladder neck of incontinent patients born with bladder exstrophy. The muscle appears to provide a leak proof, cough competent sling that increases bladder outlet resistance and, thus, provides dry intervals between catheterization. The long-term results of up to 13 years have been satisfactory.
Bladder Exstrophy↗
Trumpets of attack: collaborative efforts between nursing and philanthropies to care for the child crippled with polio 1930 to 1959.
The purpose of this historical inquiry research was to explore (a) the relationship of nursing and foundations focusing on polio from 1930 to 1959; (b) the employment and educational opportunities arising from the polio epidemics for white and black nurses, as well as the obstacles encountered; (c) the role of nursing leaders in the care of the crippled child; and (d) the effects of the resolution of the polio epidemics resulting from the polio vaccine on public attitude and on the philanthropic organizations. Relevant journals, primary and secondary sources, and personal interviews were the methods used for data collection. Because of the extraordinary community support for work related to polio, nurses were able to obtain support from foundations. This support resulted in employment and educational opportunities for bedside nursing, primarily for white nurses. Middle and upper class fear of polio enabled the development of powerful and successful private organizations to supplement the available governmental services. This research illustrates the advances that nursing has made and reminds nurses to develop and maintain strong praxis relationships, alliances with philanthropies, referrals for clients with local organizations, and a strong voice in the planning arena.
Child↗
Hodgkin and Reed-Sternberg cells in Hodgkin's disease represent the outgrowth of a dominant tumor clone derived from (crippled) germinal center B cells.
In Hodgkin's disease (HD), the Hodgkin and Reed-Sternberg (HRS) cells represent only a minute population in the diseased tissue. The investigation of lineage derivation and clonal origin of these cells has yielded conflicting results. We have analyzed HRS cells micromanipulated from infiltrated tissue sections of 10 primary HD patients for rearranged V genes, extending a previous study. Clonally related rearrangements were found in nine cases, indicating that HRS cells represent a dominant clone of B lineage-derived cells in at least a large fraction of cases of HD. Rearranged VH genes from HRS cells carried a high load of somatic mutation, indicating that HRS cells are derived from germinal center (GC) cells or their progeny. Stop codons in some in-frame V gene rearrangements suggest that the HRS cell precursors reside inside GCs, have acquired crippling mutations that prevent antigenic selection, but escape apoptosis through some transforming event.
Adolescent↗
Use of Van der Meulen principles in repair of hypospadias cripples without chordee.
The principle of Van der Meulen procedure was used for correction of 14 hypospadias cripples. The advantages and drawbacks are discussed. Follow-up ranged from one to five years. None of our patients needed a second intervention. Only one complication (urine leakage) occurred, which could be treated by application of Histoacryl glue at regular intervals and slight compression during voiding.
Child↗
Treatment modalities for hypospadias cripples.
Hypospadias cripples can be defined as patients with remaining functional complications after previous hypospadias repair. A retrospective follow-up study was performed on the long-term results of a group of 94 patients disabled by hypospadias. The records of 94 patients showed that they presented with the following problems: 82 had a major meatal dystopia (87 percent), 43 (46 percent) had residual curvature of the penile body, 19 (20 percent) showed meatal stenosis, and only 5 (5 percent) had one or more fistulas. The techniques used to solve these problems were circumferential advancement of penile skin, dorsal transposition flap of preputial skin, distally based transposition flap of penile skin, and full-thickness skin graft. Between one and nine operations were needed to achieve the desired result (mean and median of two operations). The complications after these procedures were 11 fistulas in nine patients, meatal stenosis caused by tight scarring in six patients, and a residual curvature after an orthoplasty that had to be released once before a urethroplasty could be performed. Forty-three men were seen at long-term follow-up (range, 2 to 25 years; mean, 12 years). Functional complaints that were seen included spraying at micturition (5 patients, 12 percent), dribbling (6 patients, 14 percent), and deviation of urinary stream (7 patients, 16 percent). No patients complained of painful miction, hesitation, or straining. At physical examination, 4 patients had a residual curvature (three of which were mild without functional problems), 5 had a skin surplus, 1 presented with a fistula after an operation in another hospital, and 13 had a penile torsion. Only 6 patients had a penile torsion greater than 10 degrees, which was evenly distributed to the left and right. There was no correlation between any functional complaint and the presence of a physical abnormality.
Adolescent↗
Use of buccal mucosal grafts in hypospadia-crippled adult patients.
The buccal mucosa has begun to be used as a free graft in complex hypospadias repair gradually and successfully in recent years. However, there are limited experiences regarding use of the buccal mucosa in adult patients. In this study, the authors describe their experience using buccal mucosal grafts in hypospadias-crippled adult patients. Between March 1996 and February 2001, the buccal mucosa was used in 26 cases of complex hypospadias in which local penile skin was not present or it was insufficient for urethral repair. All patients were adults (age range, 17-24 y; average, 21 y). In these patients in whom penile skin was insufficient, urethral repair by buccal mucosa was planned, with the stipulation that at least 6 months had passed from the previous operation. The buccal mucosa has been applied to 23 patients alone and in combination with penile skin in three patients. After surgery, the patients were followed-up for 3 to 18 months (average, 12 mo). During the follow-up, fistula in the line of the proximal anastomosis, meatal stenosis, and the fistula together with meatal stenosis developed in nine (35%), four (15%), and two patients (7%), respectively. It is concluded that buccal mucosa is the free graft material that should be the first choice in complex hypospadias cases that are circumcised or undergo operation more than once and when the penile skin is not available.
Adolescent↗
Planning and budgeting in the crippled children's sector through goal programming.
This article describes how the goal programming methodology was applied to a state level Crippled Children's Program. The various organizational goals are incorporated into the programming model to indicate the trade-offs associated with the resource allocation process. Alternative allocations are presented in terms of a "what if" approach to programming.
Child↗
Variability among state Crippled Children's Service programs: pluralism thrives.
The authors review the history of the Crippled Children's Service (CCS) program and report results of a survey of state CCS programs conducted in 1981. The results of the survey document extensive variability among state programs in respect to several indices, including numbers of children served, conditions covered, and services provided. With few exceptions, selected organizational, economic and demographic variables fail to correlate significantly with the variation of these indices. The strongest correlation, .40 (p less than .02) is between percentage of children served and program per capita expenditures, suggesting that relatively wealthier programs tend to serve more children. Furthermore, analyses of the survey results show that mean coverage by CCS programs of surgical disorders is significantly greater than mean coverage of medical disorders or behavioral disorders (p less than .001). The findings of this study underscore the considerable influence of historical and leadership variables on the functioning of state CCS programs.
Asthma↗
The support of the long term neurological cripple.
The term 'long term neurological cripple' is an unattractive and yet an all embracing one, covering a wide spectrum of disorders from spina bifida or cerebral palsy with or without associated epilepsy and behavioural and learning problems, through muscular dystrophy, multiple sclerosis, and motor neurone disease, to the effects of head injury, cerebrovascular lesions and the degenerative disorders of later life such as Parkinson's disease and the senile and presenile dementias. Whilst many of the problems are common to several of these entities, each has its own particular aspects.
Adolescent↗
Filarial elephantiasis of penis: a crippling manifestation.
Filarial involvement of penis in endemic areas is not an uncommon entity. In the late stage it may lead to crippling "ramhorn" penis. A case of filarial penis is presented which was successfully managed by split thickness free graft.
Adult↗
[The beginnings of care for cripples in Lower Franconia and its development into the modern rehabilitation of the physically handicapped].
On the example of Lower Franconia, a predominantly rural region which has maintained its boundaries in both world wars, the author describes the historical development of services for disabled persons since the beginning of this century. Jakob Riedinger may justly be termed the father of cripple care in Lower Franconia, having initiated the establishment, in 1910, of the first vocational rehabilitation facility for physically disabled people in Würzburg. Starting out from the provision of vocational services, further developments in particular after the 2nd world war entailed a growing recognition of the psychosocial situation of disabled persons as the basis of rehabilitative action. Several facilities have hence been established for providing holistic, early services for the physically disabled, where educators, physiotherapists, occupational and speech therapists, social workers and psychologists are involved, along with the orthopaedic doctor, in the care of physically disabled children and youths.
Persons with Disabilities↗
The management and use of data on maternal and child health and crippled children: a survey.
With the advent of the Maternal and Child Health Services Block Grant, both maternal and child health programs and crippled children's (CC) programs at the State level have assumed greater responsibility for identifying populations in need, planning appropriate services for them, and monitoring progress toward program objectives. To determine the capabilities of eight Southeastern States to produce and apply the data necessary to accomplish those tasks, a survey of data systems available to, and used by, perinatal and CC programs in the Southeast was undertaken. Findings of the survey suggested that the data available to perinatal programs were more useful for planning and evaluation than those available to CC programs, primarily due to the vital statistics data systems in each State. The major data management needs of the region include (a) measuring the health status of populations served by public perinatal programs, (b) measuring services received by population groups considered in need of public perinatal care, (c) estimating the incidence and prevalence of handicapping conditions among children, and (d) measuring the outcomes of CC programs. If these shortcomings are addressed, the programs will be in better positions for effective planning and evaluation. To improve data management and utilization capabilities, the programs may need to engage technical assistance and consultation from sources outside their service-oriented agencies.
Child↗